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FRANK S. MOORE, SBN 158029 Law Offices of Frank S. Moore, APC SUZY C. MOORE, SBN 151502 Law Offices of Suzy C. Moore 1374 Pacific Avenue San Francisco, California 94109 Telephone: (415) 292-6091 Facsimile: (415) 292-6694 Attorneys for Defendant ROSA RIVERA KEEL
IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF CALIFORNIA ) ) ) Plaintiff, ) ) vs. ) ) ROSA RIVERA KEEL AND DOES 1 through ) 10, INCLUSIVE, ) ) ) Defendant. ) / OM FINANCIAL SERVICES COMPANY, No. C07-04723 MHP DECLARATION OF COUNSEL AND REQUEST FOR JUDICIAL NOTICE IN SUPPORT OF DEFENDANT ROSA RIVERA KEEL'S SPECIAL MOTION TO STRIKE PURSUANT TO CALIFORNIA'S ANTISLAPP STATUTE [Cal. Code of Civ.Proc., 425.16] Date: January 14, 2008 Time: 2:00 p.m. Place: Courtroom 15, 18th Floor Honorable Marilyn Hall Patel
19 TO: THE CLERK OF THE COURT AND PLAINTIFF OM FINANCIAL SERVICES 20 COMPANY. PLEASE TAKE NOTICE THAT on January 14, 2008, at 2:00 p.m., or as soon thereafter 21 as the matter may be heard in Courtroom 15, 18th Floor, of the above-captioned Court, defendant, 22 ROSA RIVERA KEEL, will request judicial notice of the matters set forth herein and attached hereto 23 as authenticated by her counsel as more specifically set forth below and in the separate declaration of 24 defendant ROSA RIVERA KEEL filed concurrently herewith pursuant to Rule 201 of the Federal Rules 25 of Evidence. 26 27 28 /s/ signature on file Frank S. Moore Attorney for defendant Rosa Rivera Keel ____________________________________________________________________________________
OM FINANCIAL SERVICES COMPANY v. ROSA RIVERA KEEL, et al. Case No. C07-04723 MHP
DATED: December 3, 2007
DECLARATION OF COUNSEL AND REQUEST FOR JUDICIAL NOTICE IN SUPPORT OF DEFENDANT ROSA RIVERA KEEL'S SPECIAL MOTION TO STRIKE PURSUANT TO CALIFORNIA'S ANTI-SLAPP STATUTE 1
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DECLARATION OF COUNSEL I, FRANK S. MOORE, hereby declare: 1. I am counsel for the defendant, Rosa Rivera Keel, named in this action. I have personal
knowledge of the matters stated herein. If called as a witness, I could testify truthfully to the matters stated herein. I make this declaration in support of defendant's Special Motion to Strike Plaintiff's Complaint Pursuant to California's Anti-SLAPP Statute. 2. A true and correct copy of the complaint filed by the plaintiff OM FINANCIAL
SERVICES COMPANY is attached hereto as Exhibit "A." 3. A true and correct copy of the October 26, 2007 letter sent to my client, defendant Rosa
Rivera Keel, from plaintiff's counsel, Henry Wang, is attached hereto as Exhibit "B." 4. I was counsel for record of Rosa Rivera Keel in the matter she filed a lawsuit in last year
against Patrice Ann Pfitzer and Family Direct Insurance Services, Inc., in San Francisco County Superior Court, Case No. CGC 06-457269. A true and correct copy of the complaint I prepared on Ms. Keel's behalf is attached hereto as Exhibit "C." 5. A true and correct copy of the voluntary dismissal, without prejudice, of the complaint
in Case No. CGC 06-457269, Ms. Keel authorized me to file is attached hereto as Exhibit "D." 6. A true and correct copy of the consumer complaint Ms. Keel initiated with the California
Department of Insurance on May 20, 2007 is attached hereto as Exhibit "E." 7. True and correct copies of correspondence dated June 11, 2007, and September 27, 2007,
sent by Elizabeth Saentz, Senior Insurance Compliance Officer with the Department of Insurance, which Ms. Keel received in response to the consumer complaint she initiated with the California Department of Insurance are attached hereto as Exhibit "F." I declare under penalty of perjury that the foregoing is true and correct of my own personal knowledge. Executed at San Francisco, California on December 3, 2007.
/s/ signature on file Frank S. Moore
OM FINANCIAL SERVICES COMPANY v. ROSA RIVERA KEEL, et al.
Case No. C07-04723 MHP
DECLARATION OF COUNSEL AND REQUEST FOR JUDICIAL NOTICE IN SUPPORT OF DEFENDANT ROSA RIVERA KEEL'S SPECIAL MOTION TO STRIKE PURSUANT TO CALIFORNIA'S ANTI-SLAPP STATUTE 2
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REQUEST FOR JUDICIAL NOTICE Defendant hereby requests judicial notice be taken of the following items which are not subject to reasonable dispute in that they are capable of accurate and ready determination by resort to sources whose accuracy cannot reasonably be questioned: 1. This Court's record of the complaint and the allegations made therein (though not the
truth of the allegations contained therein) filed by the plaintiff against the defendant (Exhibit "A") pursuant to FRE 201(d); and see Mullis v. United States Bank. Ct., 828 F2d 1385, 1388, fn. 9 (9th Cir. 1987); 2. The assertion contained in plaintiff's counsel's October 26, 2007 letter sent to defendant
Rosa Rivera Keel of the reason for filing the complaint in this action pursuant to FRE 201(d); 3. The records of the San Francisco Superior Court in Case No. CGC 06-457269 (Exhibits
"C" and "D") pursuant to FRE 201(d) reflecting petitioning conduct by Rosa Rivera Keel; and see Mullis v. United States Bank. Ct., 828 F2d 1385, 1388, fn. 9 (9th Cir. 1987); 4. The public documents of Rosa Rivera Keel's consumer complaint filed with the
California Department of Insurance (Exhibit "E") reflecting petitioning conduct by Rosa Rivera Keel and to determine what statements the document contains pursuant to FRE 201(d); see also In re Silicon Graphics Inc. Secur. Litig., 183 F.3d 970, 986 (9th Cir. 1999); Bryant v. Avado Brands, Inc., 187 F.3d 1271, 1278 (11th Cir. 1999); Lovelace v. Software Spectrum, Inc., 78 F.3d 1015, 10171018 (5th Cir. 1996). 5. The public documents of the Department of Insurance in the form of correspondence
dated June 11, 2007, and September 27, 2007, sent by Elizabeth Saentz, Senior Insurance Compliance Officer, received by Rosa Rivera Keel received in response to the consumer complaint she initiated with the California Department of Insurance reflecting that an investigation is ongoing and to determine what statements the documents contain pursuant to FRE 201(d). Dated: December 3, 2007 Respectfully submitted,
/s/ signature on file Frank S. Moore Attorney for defendant Rosa Rivera Keel
OM FINANCIAL SERVICES COMPANY v. ROSA RIVERA KEEL, et al. Case No. C07-04723 MHP
DECLARATION OF COUNSEL AND REQUEST FOR JUDICIAL NOTICE IN SUPPORT OF DEFENDANT ROSA RIVERA KEEL'S SPECIAL MOTION TO STRIKE PURSUANT TO CALIFORNIA'S ANTI-SLAPP STATUTE 3
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Exhibit A
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COMPLAN FOR DECLARATORY C,·~ RELIEF(28U.S·A ·~ 2201,2202)
(-'olvi Life"), Company Life Insurance rtainti#oU Financial files this Company, Life fomerly knownasFidetityandGuaranry Insurance as and RosaRivemKeel("Defendant") alleges Defendant Complaintagainst follows: $UMMARY OF ACTION in to authorized do business Califomia OM LifE is a company in life ilmongotberthings, insumnce Califo'nria Dcfendant to and is licensed se1l, L policy issued Plaintiff to SeanKenleth by is the bcneficiaryof a life insurance policy whenMr. life the canclled subject insurance Kccl. OM Life subsequently
COMPLANT FOR DECLARATORY RELllF
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payment the policy. OM Life seeks a premium on Keel failedto maketherequisite judgmentthat its cancellation of.thepolicywasproperanddid not declaratory violateDcfendant's rightsin any manner. JURISDICTION AND VENUE 2. jurisdictionovertheclaimsin this matter This Courthassubject diversityof the tq actionpursuant 28 U.S.C.$ i 332in thatthereis a cnmplete partiesandthe amount dispurc in exceeds $75,000'Venueis properin thisdistrist in is U,S.C.$ l39l(a) ur that,interalia, Defendant located and/ordo under2S in ponionof the cvents described this business this district,anda substantial in conrplaint took placein this district, INTRADIS TRICT ASSTGNMENT 3. of Division hrsuant to LocalCivil Rule3-2,the SanFrancisco part or a fhis Courtis thepropervenuebecause zubstantial of theevsnt$ omissions in which give risetq the claim occurred theCountyof SanFrancisco' PARTIES times,OM Life wasandis a corporation At alt relevent with its principal and organized cxistingunderthelawsof the $tateof Maryland, and to piaceof husiness the $tateof Maryland,andis authorized trensact is in 4. in business the Sate of California. I hnnsacting that and and OM Life is informed believes, on thatbasisalleges, of State of was Deferrrlant andis a resident the City andCountyof SanFrarrcisco, 5. Califomia. DOESI through and of The truenflmes capacities defendants to ar or whetherindividual,corporate otherwise, uillcnown OM Life 10,inclusive, tbcso by defendants suchfictitiousnamss-When sues at this time,n'hotherefore 6. are defendants ascertained, of the tnre narnffiand capacities thefictitiouslynamcd to the OM Life will arnend Complaint reflecttheirtnrenames.
L é[ lEF F 00
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FTRSLCAUSEOF ACTTON ' 7, flleclsretorT Relief) j Plaintiffincorporates full the allegations paragraphs in I in On or about August Keelexecuted submitted 27,}QA1,Mr. aud
through6, asthoughfirlly setforth herein. 8. a'writtenapplication fsr'a $620,000 insurartce policy with anAcceierated life Death Benefitrider anda ReturnofPremiumrider. Mr. Keel elected theoptionto to payments lhepolicy,anddesignated Defendant makequarterlypremium the for as theprimarybeneficiary 9. i0. InsurancePolicy On October 2005, 10, OM Ufe issuedLife payment The Policycontains, among otherthings,a premium L053II I9 (the"Policy'). gfficepcriodprovision,whichprovides: Certlficate Date The dateon whichtheinitral premiurn dueandon whichcoverage is yearEandanniversaries certificate rnonths, starts.Prsnium duedates, aremeasured from this date,
+t**
t ,
Premlum Payments
r ,
l
AJi prerniumpayments: . Must be paidon or beforetheirduedatg, offics thatwe rnaintain. .
r Must be made our HomeOffice or anyadministrative at of of Must be in thecunency the UnitedState America. Life Insurance madspafableto Fidclif andGuaranty Company.
r May bemadeby a ourrently order datedcheckor money
J
RELIEF FoRDEcr.c-[AToRY coMpLArNT I
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becpmes for Beforeanyinsurance effective, fitst premium the , is eachteffEmustbe paid while theInsured alive. IL premiurn theamount in Mr. Keel did not paytheinitial quarterly
whentheFolicywasissued. of $378.30 12,2005, 17. In theDeliveryRequirementNotice October dated in payrnent Mr. Keel wasadvised he wasrequired make iuitial prer:nium the that to within 30 daysin order activate Policy. to the thearnount $378.30 of 13. On November 2005,OM Life sentMr- Keel anIntentto 3, if informingMr. Kcel thatthc Policywould be cancelled the Closehtotification, premiumwasnot received initial quarterly within l5 daysof thedateof theIltent to CloseNotificadon. L4, prernium within 15 Mr. Kcel did not paythe initial quarterly daysof thedateofthe Intentto CloseNotification. otlfled 15, On December 19,2005,OM Life·¡ Mr.Kecl that thc Policy was cancelled. 16. On or aboutJanuary 21,2006,m.Keel died. 17. On January 23,2006,Defendant callcd OM Life and the status ofthc Policy was discussed with her. 1 18. On or aboutr¦ 26,2006,OM Life received a check in the y a m o u n t o f S 3 7 8 . 3 0 , w h i c h · ¡æls p u r u t toe O M L i f e b y M t t K c e l a s h i s wa à sG p· o e · initial qu·\ ly prelnium pa· nt on the Policy. .Kelel a letter advising 19_ On January 27,2006,OM Life sent>ç him thatthc POlicy had ben cmcelled and thatthe S378,30 would bc retumed to hinl under se·E cover. parate ·r l ( 20, In a letter dattd Febury 9,2006,Defendant iR ZRmed OM Life, s ·oe and OM Life leamed forthe flrttirn·oe ·u ·E MI,Keel·E death_Defcndant requested opcn a duth beneflt claiIII. us ·å,sary t·oe the ro,,W n·B
& MANATTI PItELPg PI{ILL'Fs. LI.T
^f,Ut*t$! toa ^ftlss 4t L^w
,
COMPLArNT FOR DECLARATORT RELIE
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21,
the existsbetween particshereto An actuaicontroyef,sy
to with regard thePolicy. concerning riglrts,dutiesandliabilitiesof theparties the on the OM Life contends because initial preniumpaymnt thePolicywasnot that tirnq thePolicywasnof in forceat thetimeof Mr, Keel's paidwithinthercquisite 19, the and death, that 0M Life wasentitledto c.ancel Policyon December 2005. alleges, that and OM Life is informedandbelieves, on that ba^sis prior peyment thePolicywasmade on that contends the initial prernium Defendant 22. the entitledto receive benefits to the deathof Mr. Keel andthat sheis therefore undcrthePolicy. to is of 21. A deterrnination the followingissues essendal the dctemination of liability in this actioni
waS (a) WhOther the requistte premiuOEû paid IIInely in ier ns u· s a c c o r d m c e w i t h t h e l t c y T a n d o tf h h e s P b B e q u c n t e noticosi (b·l Whether OM Life w,ª cntided to cancd the Polcy:and l (C) Whether th,± POlicy wttin forcc atthe dme Ofm,Keel's. death. det rI n, 2 4 . I t i s c c oe a r y f o r t h e c o u n t O a n d ed c Icl li a F² t h e r i g h t s , n·ss
dudes and liabilities ofthe parties with FeFd tO thdr reispedivc iFe determination that DeFendantOt is·¡ obligaJons under the Policy.OMIR sZR ... ·oe e ZR 1lcd to the benefits urldcr thc Policy becal·girlilal pFemipm paymcnt Was, ell·S ,¾mderthe tuIIIS OftLE P,licy ·¡ot made within·¡e requisite ine penod,as rcqui~h subsequent,oticels, alld th·oe m // m /m /// ///
CoMPttT FOR pECttTORY RELIEF
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follows;
underthe Policy; 2. 3, faith, Datedi Se7ptembcr ll,2007 MANATT,PHELPS&PHILLIPS,LLP HENRY C.WANG CHARLES G.GOMEZ the That OM Life propcrlycancelled Policy;and by For anorderthat this actionwasbrought OM Life in good
By: ~P ittchiIFE ·Ð Q INSURANCE COMPANY,fonncrly klloWn as Fidelity and Guaranty Life c Company lnsuran·oe
411446623
coMPLAM FOR DECLARATORY RELIEF
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Exhibit B
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Henry C. WanE LtP & Phelps Phillips, Manatt, Dial:(31o)312-4143 Oirect E-mEil.hwang@manatlcom
October 26,X·l 07
095 Clim·oe ·g 221'5·] M'uça
HAND DELiVERED Kecl Rosa Riverm 291 GwrcFO Strect san Francisco,CA 94103 Re1 0M FF"·g "c,Ë fa< .Ca.·¡ rH·ç R`·a Fiyf"F ,µ ·ÆS
.C0704723 MIPl (USDC·] NDCA C·¡ Se N·oe POucy NO.L0531119
DearMs, Rivera-Keel: Company, Life you I am writing this letterro advise thatOM Frnancial lnsurance this ("OM Life") hasretained Company Life Insurance ur formerlyl,mown fideUty andCuaranty to that I l9 (the"Policy") wasissued yourlate No, L0531 witfr law firm in connecrtion Polioy that Keel. This lctter*tt atsoinform you of thesteps OM Lifc hastakenrecemtly Sean husband We underthc Policyis beingfairly considered' have thatygur claim for bErrcfits ensufe to surrounding the regarding circumstances documcntation the compiledandreviewed available factsand of underthePolicy, Belowis a briefsummary thc relevant youiclaim for benefits records: tbr awrittenapplication and on or aboutAuSrst2?, ?005,Mr. Kcel executed submitted rideranda Returnof DeathBenefil policy with anAccclef,aled a $620,000lifeinsuranJe paylrentsfor thepolicy' premium the Premiumrider, Mr' Keefclecred optionto makequartcrly a otherthings" among the on october 10,2005,oM Life issucd Policy,whictrcontains, provides: prol'rsion, which graceperiod paymerrt prerniurn
Cerflficate Date $tarts' The date on which the initial prcmium is due and on which aovrage arc prErnium due dates,cr"tiitrcatl months, years,and annivcrsanes measured firm this date. Premium Paymeuts All prernium payments: r Mus tre paid on qr bcfore their due date'
Telephone1 310 312.4000 Fax: 31o,312.4224 Sacrament·oeSan Francisco l WaShingt·oe:1,DC I
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rnanatt
ftnattl PhetPs JPhflflPs
RosaRivera Keel October 26,2047 Page3
andis not waiving anyof its right$' to To date,OM Lifc continues standby its decision Io youl interestsasit.gives to its Nevertheless,in an effort to give at least8$much consideration j*"ia*O to deferthis matterto an impartial tribunal- To that end,OM own interests,OM Life has statesDistrict court frtr the }rqrthern Ljfe has filed a declaratoryrelief action in rlreunited v' Ross Fiv3raKe-el Ca'se District of Califomia entiiled OM FinanciatLife Insurance.Comryary or damuges nnv falm ofNo. C07-04723(MHPt(the "Action"). otvt l-itt is not seeking the it is requesting Court to declarcthe ,"lief againstyou in the Action- lnstad, ;;;*y documerts if any, under the Folicy. Enclosedwith this letter are fr*ti*r;iight* *i"Uligltions, For DeclaratoryRelief' (3) Otiler relating to the Actron. l)rey are: (1) Summons'(2) Clmplaint fiendlines,(4) SrandingOrder for All Setting lnitial CaseManagEnentconference;;.1 ,+un (5) Standingfuers of Chief JudgeMarilVn Judgesof the Northenr ni-strict of California, and Hall Patel. good faith effort to have an In summary the fihng of ttruAclion reflestsoM Life's againstyou' not seekany damages rloes impartial rribunal ,"r.i** rhiJmatter. While the Action aIe numerousdocunsnts to be fi]d wc rcofilmendthat you Obtain]egal representation'There Forinstancc' the enclosedOrder and deadlinesthat must be met in the upcoming monttts on the partiesto rneet-and-confer riquiles Setting Iriitial C"** tut*rr"g"*ent Confererrce on Statement CaseManagement Joint December3,2007 t"g;Ai'ng the caseand lo file a December17,2907. call me at (310)312-4143' please If you havo any questions,
[g
Enclosures
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Exhibit C
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delivered to decedent by said defendants. Plaintiff ROSA RIVERA KEEL is the successor in interest to decedent as defined in Section 377.11 of the California Code of Civil Procedure and succeeds to the decedent's interest in the action or proceeding and no other person has a superior right to commence the action or proceeding or to be substituted for the decedent in the pending action or proceeding. 2. Plaintiff is informed and believes and thereupon alleges that defendant PATRICE ANN
PFITZER is a resident of the County of Sacramento. She is licensed by the State of California (License #0E67175) as a life insurance agent and is therefore authorized by and on behalf of a life, disability, or life and disability insurer to transact life, disability, or life and disability insurance. 3. Plaintiff is informed and believes and thereupon alleges that defendant FAMILY
DIRECT INSURANCE SERVICES, INC., is a California Corporation with its principal place of doing business at 870 Glenn Drive, Folsom, California, and is licensed by the State of California (License# 0B29335) as a life insurance agent and is therefore authorized by and on behalf of a life, disability, or life and disability insurer to transact life, disability, or life and disability insurance. 4. Plaintiff is ignorant of the true names and capacities of DOES 1 through 25 herein and
will pray for leave of Court to insert the true names and capacities of such defendants when they become known or are ascertained together with appropriate charging allegations. 5. Plaintiff is informed and believe and thereupon alleges that each of the defendants named
herein were the agents, employees, or representatives of each of the remaining defendants, and in doing the things herein mentioned, were acting in the course and scope of such agencies and employment. 6. San Francisco County is the proper venue for this action San Francisco County is the
county where the contract was entered into and/or where the transaction or any substantial portion thereof was to be performed. STATEMENT OF FACTS 7. On or about August 27, 2005, decedent contracted with defendants PATRICE ANN
PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC., to secure a life insurance policy with a death benefit coverage of $620,000 for his wife, plaintiff ROSA RIVERA KEEL. Decedent filled out an application for said policy and delivered it to defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC. A true and correct copy of said application for life
____________________________________________________________________________________
K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
2
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insurance is attached hereto and incorporated herewith as Exhibit "A." 8. Sometime after August 27, 2005, but before September 10, 2005, defendant PATRICE
ANN PFITZER, on behalf of defendant FAMILY DIRECT INSURANCE SERVICES, INC., sent an undated letter to decedent informing him that his application for life insurance had been received. The letter also informed decedent that the check for the initial premium was not included with the application. Defendant PATRICE ANN PFITZER, on behalf of defendant FAMILY DIRECT INSURANCE SERVICES, INC., informed decedent that his application could not be processed until his premium check was received. A true and correct copy of said letter is attached hereto and incorporated herewith as Exhibit "B." 9. Defendant PATRICE ANN PFITZER's undated letter (Exhibit "B" hereto) provided
decedent two plans to select to effect payment. a. The first option, entitled "MONTHLY PAYMENT SYSTEM", instructed decedent that he could: i. ii. Sign a purportedly enclosed "authorization"; Write "VOID" on a check from his checking account and return it with his signed authorization; and iii. Write a check payable to "F&G 20/20 ROP" for $97.47, which would pay for the first month after the policy was issued and future payments would be drawn from his checking account; or b. The second option, entitled "OTHER PREMIUM MODES", instructed decedent that he would be billed directly at his home on either: i. ii. iii. 10. Quarterly at $281.58; Semi-annually at $552.33; or Annually at $1,083.00. (Exhibit "B.")
Defendant PATRICE ANN PFITZER's undated letter (Exhibit "B" hereto) instructed
decedent that if he chose one of the payment modes, to enclose a check made payable to "F&G 20/20 ROP" for the amount representing the mode he chose. The undated letter also states that all future premium notices would be sent to decedent's home. (Exhibit "B.")
____________________________________________________________________________________
K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
3
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11.
Decedent chose the first option, "MONTHLY PAYMENT SYSTEM", as the mode for
payment. On or about September 10, 2005, decedent sent a check dated September 10, 2005 (Check No. 93) to defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC., payable to "F&G 20/20 ROP" for $97.47. Plaintiff is informed and believes and thereupon alleges that either decedent or an agent of defendant FAMILY DIRECT INSURANCE SERVICES, INC., wrote the word "VOID" over the check. A true and correct copy of Check No. 93 is attached hereto and incorporated herewith as Exhibit "C." Plaintiff is informed and believes and thereupon alleges that decedent sent no other check to defendant FAMILY DIRECT INSURANCE SERVICES, INC., than Check No. 93. 12. On or about September 19, 2005, defendant PATRICE ANN PFITZER, on behalf of
defendant FAMILY DIRECT INSURANCE SERVICES, INC., certified that she asked the questions contained in the application for the policy of life insurance (Exhibit "A") and duly recorded the answers. Defendant PATRICE ANN PFITZER, on behalf of defendant FAMILY DIRECT INSURANCE SERVICES, INC., also certified that, to the best of her knowledge, there was nothing affecting the insurability of any persons proposed for the insurance as stated in the application. Defendant PATRICE ANN PFITZER, on behalf of defendant FAMILY DIRECT INSURANCE SERVICES, INC., also certified that, if the initial premium was paid with the application, she had remitted it to the insurer and delivered a Conditional Receipt to the Owner. Defendant PATRICE ANN PFITZER, on behalf of defendant FAMILY DIRECT INSURANCE SERVICES, INC., also certified that, if Disclosure Statements were required by the state, she had given them to the applicant. Finally, defendant PATRICE ANN PFITZER, on behalf of defendant FAMILY DIRECT INSURANCE SERVICES, INC., also certified that, she witnessed the signature of decedent on the application for the policy of insurance. These certifications appear in, and were made a part of, the bound policy delivered to decedent, Policy No. L0531119. A true and correct copy of Policy No. L0531119 issued by Fidelity and Guaranty Life Insurance Company is attached hereto and incorporated herewith as Exhibit "E." 13. On October 19, 2005, defendant PATRICE ANN PFITZER, on behalf of defendant
FAMILY DIRECT INSURANCE SERVICES, INC., sent decedent a letter with the enclosed policy for life insurance (Policy No. L0531119). The October 19, 2005 letter defendant PATRICE ANN PFITZER
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K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
4
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sent to decedent states: "Please find your new policy attached. This sensible and economical coverage can be used to pay off your $620,000 mortgage if you die. It provides quality protection for your family affordability and peace of mind for you." The October 19, 2005 letter defendant PATRICE ANN PFITZER sent to decedent also states: "Please make a record of the following information: Your policy number is: L0531119 Your policy date is 10/10/2005 The coverage amount is: $620,000 The current quarterly premium is $378.30 A true and correct copy of the October 19, 2005 letter defendant PATRICE ANN PFITZER sent to decedent is attached hereto and incorporated herewith as Exhibit "D." 14. Policy No. L0531119 (Exhibit "E" hereto) contained a certificate of life insurance from
Fidelity and Guaranty Life Insurance Company that decedent had obtained a policy of life insurance as requested from defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC. 15. Policy No. L0531119 (Exhibit "E" hereto) contained a page which stated: "Sean K. Keel
(decedent), the following requirements must be met within 30 days to activate your policy. If you have any questions feel free to call our Service Center at 1-888-513-8797. Policy is being issued with a quarterly premium of $378.30. Need initial premium in the amount of $378.30." However, also bound within Policy No. L0531119 (Exhibit "E" hereto) was a copy of Check No. 93 made payable to "F&G 20/20 ROP" for $97.47 with the word "VOID" written across it (Exhibit "C" hereto) along with defendant PATRICE ANN PFITZER's certifications set forth in paragraph 12 herein. 16. Plaintiff is informed and believes and thereupon alleges that decedent believed that he
had bound the insurance coverage in Policy No. L0531119 by choosing the first option, "MONTHLY PAYMENT SYSTEM", outlined in defendants' undated letter (Exhibit "B" hereto). Plaintiff is informed and believes and thereupon alleges that defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC., never informed decedent that the policy had not been bound over by sending Check No. 93 made payable to "F&G 20/20 ROP" for $97.47. Neither defendants PATRICE ANN PFITZER nor FAMILY DIRECT INSURANCE SERVICES, INC., executed the "MONTHLY PAYMENT SYSTEM" selection outlined in defendants' undated letter (Exhibit "B"
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K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
5
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 21 of 102
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
hereto) or informed decedent that his choice of the "MONTHLY PAYMENT SYSTEM" was defective in any way. 17. 18. Decedent was tragically killed on January 21, 2006. Shortly after learning of her husband's death, plaintiff ROSA RIVERA KEEL consulted
Policy No. L0531119 (Exhibit "E" hereto) and arranged to have a friend who worked for an insurance company review it. Plaintiff's friend informed her that it appeared that the policy was in effect because an original policy had been delivered to decedent. On January 22, 2006, plaintiff made payment of $378.30 as the premium for Policy No. L0531119 (Exhibit "E" hereto). A true and correct copy of the bank transaction reflecting said payment is attached hereto as Exhibit "F." 19. On or about January 25, 2006, plaintiff telephoned Fidelity and Guaranty Life Insurance
Company to inquire about the status of Policy No. L0531119. In response to her inquiry, Fidelity and Guaranty Life Insurance Company sent plaintiff a letter dated January 27, 2006, informing her that Policy No. L0531119 had been closed as "incomplete due to outstanding requirements." A true and correct copy of Fidelity and Guaranty Life Insurance Company's January 27, 2006 letter is attached hereto and incorporated herewith as Exhibit "G. 20. On January 27, 2006, plaintiff ROSA RIVERA KEEL telephoned defendant PATRICE
ANN PFITZER to inquire about the status of Policy No. L0531119. Defendant PATRICE ANN PFITZER told plaintiff that the policy was in effect and that she had submitted all the necessary paperwork to Fidelity and Guaranty Life Insurance Company and that there should not be a problem. Plaintiff informed defendant PATRICE ANN PFITZER that Fidelity and Guaranty Life Insurance Company had told her that there was no policy in effect. Defendant PATRICE ANN PFITZER informed plaintiff that she should telephone Fidelity and Guaranty Life Insurance Company back and inform it that the policy had been delivered to her deceased husband. Plaintiff informed defendant PATRICE ANN PFITZER that Check No. 93 made payable to "F&G 20/20 ROP" for $97.47 was in Policy No. L0531119. 21. On February 7, 2006, Fidelity and Guaranty Life Insurance Company sent plaintiff a
check made out to "Sean K Keel" for $378.30 with the designation "Policy Suspense." A true and correct copy of said check is attached hereto as Exhibit "H."
____________________________________________________________________________________
K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
6
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 22 of 102
1 2 3 4 5 6 7 8 9 10
22.
On February 10, 2006, plaintiff sent a letter dated February 9, 2006, via certified mail,
to Fidelity and Guaranty Life Insurance Company informing it of her husband's death and that the death had occurred during the grace period of Policy No. L0531119 and requested that forms be sent to her to open a death benefit claim. The letter was carbon copied to defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC. A true and correct copy of plaintiff's February 9, 2006 letter is attached hereto and incorporated herewith as Exhibit "I." Neither Fidelity and Guaranty Life Insurance Company or defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC., responded to plaintiff's February 9, 2006 letter. FIRST CAUSE OF ACTION [Negligence] 23. Plaintiff re-alleges and incorporates by reference all preceding paragraphs. Decedent contracted with defendants PATRICE ANN PFITZER and FAMILY DIRECT
11 24. 12 INSURANCE SERVICES, INC., to secure a life insurance policy with a death benefit coverage of 13 $620,000 for his wife, plaintiff ROSA RIVERA KEEL, the intended beneficiary. This contract as 14 alleged herein, like every contract entered into in California, imposed duties on the defendants, and each 15 of them, to perform said contract with care, skill, reasonable expedience, and faithfulness the things 16 agreed to be done. By entering into the aforementioned contract, defendants PATRICE ANN PFITZER 17 and FAMILY DIRECT INSURANCE SERVICES, INC., undertook professional and business 18 engagements that required them to exercise care, skill and knowledge as implied in such agreements in 19 favor of its client, the decedent, and on behalf of the intended beneficiary, plaintiff ROSA RIVERA 20 KEEL. 21 25. 22 SERVICES, INC., as insurance agents, had the duty to exercise good faith, use reasonable care, 23 diligence, and judgment in procuring the insurance requested by its client, the decedent, on behalf of 24 the intended beneficiary, plaintiff ROSA RIVERA KEEL. 25 26. 26 damages as a consequence, namely, the loss of the death benefit her husband sought for her benefit in 27 the event of his death, the loss of economic well-being the death benefit was designed to accomplish 28 The acts and/or omissions alleged herein breached these duties. Plaintiff suffered In addition, defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE
____________________________________________________________________________________
K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
7
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 23 of 102
1 2 3 4 5 6 7 8
and the mental anguish associated therewith. It was reasonably foreseeable that had defendants, and each of them, failed to uphold their duties, decedent and his beneficiary, the plaintiff, would be harmed. 27. The acts and omissions of defendants alleged above demonstrated a wanton and reckless
conscious disregard for the rights and well-being of the interests of the plaintiff, entitling her to penalties or punitive or exemplary damages based on the actual harm suffered by her. WHEREFORE, plaintiff prays for relief as hereinafter provided. SECOND CAUSE OF ACTION [Constructive Fraud] 28. Plaintiff re-alleges and incorporates by reference all preceding paragraphs. Decedent reposed his utmost trust and confidence in defendants as insurance agents to
9 29. 10 help him bind and secure life insurance for his spouse in the event of his death. Defendants PATRICE 11 ANN PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC., knew, or had a duty to know, 12 that decedent desired to obtain a life insurance policy wherein his wife would be the direct beneficiary 13 of such policy in the event he died. 14 30. 15 SERVICES, INC., knew, or had a duty to know, that decedent had exercised the option to pay the 16 premiums for the purchase of Policy No. L0531119 through the "MONTHLY PAYMENT SYSTEM" 17 option outlined in defendants' undated letter (Exhibit "B" hereto). Defendants PATRICE ANN 18 PFITZER and FAMILY DIRECT INSURANCE SERVICES, INC., also knew, or had a duty to know, 19 that decedent would reasonably have relied upon the October 19, 2005 letter sent by them (Exhibit "D" 20 hereto) informing him that the life insurance policy had been purchased, the delivery of Policy No. 21 L0531119 to the decedent reinforcing that view and the failure to notify decedent that he had not 22 effectively exercised the option to pay the premiums for the purchase of Policy No. L0531119 through 23 the "MONTHLY PAYMENT SYSTEM" option. Defendants PATRICE ANN PFITZER and FAMILY 24 DIRECT INSURANCE SERVICES, INC., knew, or had a duty to know, that decedent's reliance on 25 correspondence from them and the delivery of Policy No. L0531119 to him would induce him to believe 26 that he had bound insurance as contracted with them. 27 28 Defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE
____________________________________________________________________________________
K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
8
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 24 of 102
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
31.
Defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE
SERVICES, INC., intended to induce action by the decedent to arrange for the life insurance policy he contracted with them to obtain and decedent was so induced. Decedent also did not have reason to believe that he had not bound the life insurance policy based upon the representations made to him by the defendants. 32. The acts and/or omissions alleged herein breached the aforementioned duties. Plaintiff
suffered damages as a consequence, namely, the loss of the death benefit her husband sought for her benefit in the event of his death, the loss of economic well-being the death benefit was designed to accomplish and the mental anguish associated therewith. It was reasonably foreseeable that had defendants, and each of them, failed to uphold their duties, decedent and his beneficiary, the plaintiff, would be harmed. 33. The acts and omissions of defendants alleged above demonstrated a wanton and reckless
conscious disregard for the rights and well-being of the interests of the plaintiff, entitling her to penalties or punitive or exemplary damages based on the actual harm suffered by her. WHEREFORE, plaintiff prays for relief as hereinafter provided. THIRD CAUSE OF ACTION [Negligent Misrepresentation] 34. Plaintiff re-alleges and incorporates by reference all preceding paragraphs. Defendants PATRICE ANN PFITZER and FAMILY DIRECT INSURANCE
18 19 20 21 22 23 24 25 26 27 28 35. SERVICES, INC., as insurance agents, had the duty to disclose to its client, the decedent, that he was under a mistake as to facts basic to the transaction, namely, that his attempt to exercise the option to pay the premiums for the purchase of Policy No. L0531119 through the "MONTHLY PAYMENT SYSTEM" option was insufficient. Because of the customs of the trade of insurance agents and/or the other objective circumstances of the transaction as alleged herein, decedent, or any other reasonable person who had engaged in such a transaction, would reasonably expect disclosure of those facts. 36. The acts and/or omissions alleged herein breached these duties. Plaintiff suffered
damages as a consequence, namely, the loss of the death benefit her husband sought for her benefit in the event of his death, the loss of economic well-being the death benefit was designed to accomplish ____________________________________________________________________________________
K EEL, v. PFITZER, et al.
VERIFIED COMPLAINT FOR DAMAGES
9
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 25 of 102
that had defendants, and therewith. It was reasonablyforeseeable and the mental anguish associated the and his beneficiary, plaintiff, would be eachof them, failed to uphold their duties,decedent harmed. 37. a allegedabovedemonstrated wantonand The actsand omissionsof defendants
of for recklessconsciousdisregard the rights and well-beingof the interests the plaintiff, entitling her basedon the actualharm sufferedby her. to penaltiesor punitive or exemplarydamages WHEREFORE, plaintiff prays for relief as hereinafterprovided. PRAYER as WHEREFORE, defendant follows: L damages, including That plaintiff be awardedgeneral,specialand consequential
of damages an amountin excess the jurisdictional limit and in as emotionaldistress, compensatory according to proof; 2. in be That cross-complainant awardedpunitive damages an amount sulficient to
punish and deter defbndants; 3. 4. F'orintereston all damages; and For suchother and further relief as the Court deems.just proper.
Dated:October 23,£2006
Respectfullysubmitted, Law Offices of Frank S. Moore. APC
Attomey,¨ r plainti·è ·¡OSA RIVERA KEEL
7 R ,É ,v ·OE 72·¡ ,`·OE EEÇ ·OE ,µ `·OE VERIFIED COMPLAINT FOR DAMAGES
10
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 26 of 102
I, ROSA RIVERA KEEL, am a party to this action. I have readthe foregoingVHRIFIED The mattersstatedin the VERIFIED COMPLAINT F'OR DAMAGES and know its contents. COMPLAINT FOR DAMAGES are true basedon my own knowledge,exceptas to thosematters statedon information and belief. and as to thosemattersI believethem to be true.
that penalty perjury of underthelawsof the State California the foregoing of I declare under is trueandcorrect.
California. Executed Octoberl9 2006,at SanFrancisco, on
·u ¡ ·¡ R,s · · KEEr,1,PF·OEr··OE VERIFIED COMPLAINT FOR DAMAGES
Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 27 of 102
Law Officesof FrankS. Moore,APC
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Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 28 of 102
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Document 9
Filed 12/03/2007
Page 31 of 102
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Document 9
Filed 12/03/2007
Page 32 of 102
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Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 33 of 102
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Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 34 of 102
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Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 35 of 102
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Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 36 of 102
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Case 3:07-cv-04723-MHP
Document 9
Filed 12/03/2007
Page 37 of 102
';liJi*'tl'1ffitffi ti#$r:r#H;rffi durinscacnpropofo # '"L-"J*iuni' ptis$-gt' Ei;;,i:i;E;il1rl15:d}jg#fg:'$ffi ,H:l*rffi,$fi aro. oi-o{ifi.aJrr 'r"ti.. erert unleEs {ffi iniuii[iiity '11111 ":tttff"F-l1'3il*10'1flffi,il H;ft*dilhi"s
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and for life insurance' ls i'r,ranigsr, my uenerrr rwords,phrrmarry "mproyoito'gi"".* or anyrnembcr'"i"nyiii;iiv who applying ,*gi'LrT"5 1s whiclrnrayhe pertine*nr thq svaiuatiu" f'rmilywho is also'rpplyingfor informrtion nty coniutler "po't on tle il^'ol any menrber'of to otrtainan invq'Stigativc wlrichmry be requestetl prePare ug*ucv the I alsoauthorize Insurer.to by () i"t'ir*r t'iU* intqiu'i"#cd anv:..",,t-lT'*L:*l*iting if intervicw requeited: I unrterrtansi-hJtiii* ftq''jii' Chkli litu insurance, nd--t irusinets ct'ntatred'a'.,'iing +s illncss definedin *']l sucha re*rrl a5lsng as, .# ,.lion"'Uiy'he Rirler r'rJ',,erit antl l.am laterdiagnosecl ponitrnof nrv'encJ* early'tre iLolTintl the.Accelerarccr ,..,_rr]es thar I untJerstand if my."rorg* ir-r*ril sr_cei**rE receive.a a."i'r, rereiPt otthe c.ertificate drdt orb'+rnenu up I the rit,er, mayrccerve t, s-tiv" "r'|Jiily:, *irr*.TroY::ffiili'f?{',:ni*iil;iilit-t!*i*;*i"*,1*,;d
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which insurance to Inrav tor orher companics apprv trffin$il";l*;l;l,ll;'*ruJfo'i,',i;-:":lilH:;liifrT'.t maytresubmittctl' or will covcra8e to whicl'ta ctairn Authurization tE as healtt insurance of
copy this life or r"r'" p*ri"o of .tt) m'nrrrs;a phora6raphic wi, ThisAuthorizarion rrc v.rrid.irc* ,l* glg-liglP-o'--*n-tf,hd icccivea copyof thisAuthorization' to benefiti' and/or for valicl theoriginul;l, or flnyof our represenutiues as U*rmirre eligibility insurance by u" .,f'f i""'l'*'ization will t* "i-Ai" tlre on provirled thisform are Numbers I understandthat informiit'n otrt'rirted gocialsecurity rax tdentificatioa or 'il"*V of unclcrthe perraliiel PeriuryI certi{y certification:
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Case 3:07-cv-04723-MHP
Document 9
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Page 38 of 102
Exhibit B
Case 3:07-cv-04723-MHP
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SeanK. Keel 1450OakdaleAvenue SanFrancisco,CA 94124 DearMr. Keel: Your applicationhas beenreceived. ftrant you for your participation.Pleasenote that your check for the initial premium was not includedwith your materials. YOUR APPLICATION CANNOT BE PROCESSED UNTIL YOUR PREMIUM CHECK IIAS BEEN RECEMD. Pleaseselecta plan from below: MONTHLY PAYMENT SYSTEM withdrawnfrom your checkingaccounteachmonth. The monthly Your premium can lre automatically premiumis only fi91.47. If you want to utilizethis system,please the following: do authorization in 1) Sign the enclosed whereindicated the "X", andhighlighted yellow. by 2) Write "VOID" authorization. on a check from your checking account and return it with your signed
ROP" for fi97.47. This will pay for the first month after the 3) Write a check payableto "F&G 2fr120 will be drawnfrom your checkingaccount. policy is issued. Futurepayments IIUM MODES OTHER PREW If you prcfcr to be billed directly at your hornc, yOu may pay prcmiums on either a quarterly, selnianllual,or an annual prenlium lnode. The respectivc amounts arei
QuarterlyrS281.58
annual:$552.33 Senli·d
Annual:$1083.00
]20/20 If you choose one ofthcse direct paymentinodcs,pleasc enclose a check made payable to"F&·k e chosen. All future prcllliunl notices will bc sent to ROP"for thc amount representing the inodc you,, your home. TO ASSIST IN ASSURING YOUR PARTICIPAT10N AT THE LOW RATES YOUiVE BEEN QUOTED,AND TO FACILITATE THE PROCESSING OF YOUR POLICY,YOU AZM ENCOURAGED TO RETURN THE A30VE REQUIRMENTSIN E ENCLOSED TU ee to call me ENVELOPE TODAY. As always,if you should need assistance,Plcase tcl fl·E at l·\ ·\·] 800-259-3430 ext.121. Thank you` ·\ Sinccrcly, Patricc Pfitzer Farnily Direct lnsurance Services,Inc.
Case 3:07-cv-04723-MHP
Document 9
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Page 40 of 102
Exhibit C
Case 3:07-cv-04723-MHP
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Exhibit D
Case 3:07-cv-04723-MHP
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Page 43 of 102
DearMr. Keel: coverage can be usedto This sensible and economical Please find your new policy attached. quality protectionfor your family you die. It provides mortgageif pay off your $620,000 andpeflceof mind for you. affordability
makea record of the following information: Please Your policynumberis:L0531119 Your policydateis:1011012005 amountis:$620'000 The coverage The current quarterlypremiumisl$378.30
we strength be our people. Because havefamilies, to our We at Family Direct consider greatest or just like you, we know you needgoodservice value. If you shouldhavequestions need and helpful. Thank vou. call service,please us. You'll find us to be friendlyand
Very Truly Yours, PatricePfitzer Representative CustomerService ext. at P.S. You canreachme personally l-800-259-3430 121.
870 Glenn prive·\ Folsom.CA 95630 PROTECT10N FOR YOUR FAMILY.·c PEACE OF MIND FOR YOU
Case 3:07-cv-04723-MHP
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Page 44 of 102
Exhibit E
Case 3:07-cv-04723-MHP
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Case 3:07-cv-04723-MHP
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page Information and named theCertificate on to is certificateissued theOwner This the may examtne Group PolicyYou the undel Group coverage the evidences lnsured's of the inconsideratton is This pofi.V theoffice thepolicyilolder, certificateissued of ut of and application payment premiums' the dres if benefit thelnsured before we pay is While certiflcate ineffect, witt thedeath this to subject thiscertificate's will payment bemade of rxfi6tionDate anyterm.Any provisions, is of This CAREFULLY. certificate lifeinsurance partof a legal CERTIFICATE YOUR READ and ierms contains This and thepolicyholder theCompany. ceriificate between contract Policy' the under Group to that provisions areapplicableallOwners for Signed theComPanY'
·OE
· g m , Ý
·]
·ç President
AGENT NAME AND ADDRESSi PATRlCE PFITZER P o Box127 FOLSOM,CA 95763
c F ·· ablel ·· apÏ countersigned at
City: ByAgent:
State:
Date
return within20days it this not lf TO RIGHT CANCEL. youdecide to keep certificate, to or to maybereturned anyof our agenis it maybemailed us' it. receive lt .ft., yo|.l paid Any witt this certificate voidit fromthe beginning' premium will in, ,Ltutnof of within10daysof ourreceipt thiscertificate' any We berefunded. will make refund CERTIFICATE LIFE INSURANCE TERM TEVEL GROUP
LIFE TERM
questions lf T0 NOTICE OWNER: youhave or this about cedificateif orne*dinfotmation a complaint, in resolving assistance vouneed 3-8797 call olease usat 1-888-51
Expiration and is the while Insured alive untilthe in are Premiums payable advance premium will renewal each Period, Guarantee Premium term. Afterthe of Eate each OF in shown theTABLE TotalPremium Maximum thantheGuaranteed not bemore if is to Renewable age95. Deathbenefit payable PREMIUMS, nt-flqU* RENEWAIis in effect' Date the dies lnsured before Expiration andwhilethiscertificate are dividends notpayable Nonparticipatingl
99) C(12·] FGL RTRC·]
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Page BENEFICIARY of ................. Change Beneficiary(ies) Beneficiary(ies) lrrevocable ,,,, to PaymentBeneficiary(ies) ,,,..,.,,.,.... ,W ,W ,W ,W
OWNERSHIP
Owner Change Owner Contingent of and Rights Ownership Ownership Succession PREMIUMS Premium$....... Adjustment of Renewal Grace Period.. Premium Payments Renewal.........
1 .......................,. REENTRY OPTt0N......... 1 ................ New Ceriificate 1 and Suicide Incontestabi|itv.........................
1 ...................... RETNSTATEMENT .....,......... 1 ............. Effective of Reinstatement Date .....,..,.,,,..,, 1 Reinstatement Reouirements
follow 16, benefits Page restrictions, oradditional riders, Any endorsements,
Page 2
(12-9e) FGL RTRC-C
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3 Page
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4 Page
ED ON rTA3LE CONrlNÒ NEXTPACEl
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Page (Continued) 4
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4 Page (Continued)
EE1 01V IVEXTPACFl F COIVTINÒ fTABÇ
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4 Page (Conilnued)
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Agelnsured'sAgeonhisorhernearestor|astbirthday. Beneficiary the to on change record receive death recent or in named theapplicationin themost Theperson(s) benefit. due Premium dates, starts. coverage on premium dueand which is the on Thedate which initial from are years, anniversariesmeasured thisdate' and months, ceriificaie the to change record receive death on recent or in named theapplicationinthemost Theperson(s) death. at is not if benefii theBeneficiary alive thelnsured's of the to on change record become owner recent or in named theapplicationinthemost Theperson(s) the dies if the certificate Owner before lnsured' this
Date certificqte
contingent Beneficiary contingent Owner
Date Expiration
Amount Face policy Group lnsured
renewa, fiH!,Jlililll'15Jil.il"'lfiHHT#?oeJanv l[--+?l:#rH5lrTl;"?'--;tHiplSru Date' preceding Expiration
the after is term oneyear DATA CERTIFICATE in under is and in coverage effect which shown life of Theamount ierm insurance section' INFORMATION theCERTIFICATE is which certificaieissued, this Policy Term Insurance under Life TheGroup life section INFORMATION whose is DATA CERTIFTCATE in iheCERTIFICATE under named Theperson this under ceriificate. insured who on recent change record, isentitled or in in as named Owner theapplication, themost Theperson(s) certificate' in rights totheownership staled this section' INFoRMATION OERTIFICATE under Policy shown as of Theowner iheGroup
'wner policyhotder
We,our,Us,CompanyFidelityandGuarantyLife|nsuranceCompany. Request written (if dated, notarized required and must request besigned, by io written usandreceived us. That A request to on bytheform) a fom sati$factoryus, TheOwner,
Your You.
5 Page 99) FGL RTRC·] C(12·]
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Owner, Contingent Owner, Beneficiary, inevocable Beneficiary, Contingent to AnyreferenceBeneficiary, persons. payee, include multiple may and/or
Contract Entire
of: and beiween Conkactholder usconsists the contract Theentire contraci, 1.TheGroup a of and is a copy application, oi which attached made part theContract; 2.TheContractholdels and are which attached; and endorsements riders, 3.Allamendments, panicipant. as contract to each 4,Theentire participant of: consists contracl t0 each as Theeniire contract; 1,TheGroup 2.This Certifiate; and a of and is of a cgpy which
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